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Bronchoscopy

What is bronchoscopy?

Bronchoscopy is a procedure to look directly at the airways in the lungs through a thin, lighted tube (bronchoscope). The bronchoscope is put in the nose or mouth, moved down the throat and trachea (windpipe), and into the airways. A healthcare provider can then see the voice box (larynx), trachea, large airways to the lungs (bronchi), and smaller branches of the bronchi (bronchioles).

There are 2 types of bronchoscope: flexible and rigid. Both types come in different widths.

A rigid bronchoscope is a straight tube. It’s only used to view the larger airways. It may be used within the bronchi to:

Remove a large amount of secretions or blood

Control bleeding

Remove foreign objects

Remove diseased tissue (lesions)

Perform procedures, such as stents and other treatments

A flexible bronchoscope is used more often. Unlike the rigid scope, it can be moved down into the smaller airways (bronchioles). The flexible bronchoscope may be used to:

Place a breathing tube in the airway to help give oxygen

Suction out secretions

Take tissue samples (biopsy)

Put medicine into the lungs

Why might I need bronchoscopy?

A bronchoscopy may be done to diagnose and treat lung problems such as:

Tumors or bronchial cancer

Airway blockage (obstruction)

Narrowed areas in airways (strictures)

Inflammation and infections such as tuberculosis (TB), pneumonia, and fungal or parasitic lung infections

Interstitial pulmonary disease

Causes of persistent cough

Causes of coughing up blood

Spots seen on chest X-rays

Vocal cord paralysis

Diagnostic procedures or treatments that are done with bronchoscopy include:

Biopsy of tissue

Collection of sputum

Fluid put into the lungs and then removed (bronchoalveolar lavage or BAL) to diagnose lung disorders

Placement of a small tube (stent) to keep an airway open (stent placement)

Drainage of an area of pus (abscess)

Your healthcare provider may also have other reasons to advise a bronchoscopy.

What are the risks of bronchoscopy?

In most cases, the flexible bronchoscope is used, not the rigid bronchoscope, because it has less risk of damaging the tissue, patients tolerate it better, and it provides better access to smaller areas of the lung tissue.

All procedures have some risks. The risks of this procedure may include:

Bleeding

Infection

Hole in the airway (bronchial perforation)

Irritation of the airways (bronchospasm)

Irritation of the vocal cords (laryngospasm)

Air in the space between the lung covering (pleural space) that causes the lung to collapse (pneumothorax)

Your risks may vary depending on your general health and other factors. Ask your healthcare provider which risks apply most to you. Talk with him or her about any concerns you have.

In some cases, a person may not be able to have a bronchoscopy. Reasons for this can include:

Severe narrowing or blockage of the trachea (tracheal stenosis)

High blood pressure in the lungs’ blood vessels (pulmonary hypertension)

Severe coughing or gagging

Low oxygen levels

If you have high levels of carbon dioxide in the blood (hypercapnia) or severe shortness of breath, you may need to be on a breathing machine before the procedure. This is done so oxygen can be sent right into your lungs while the bronchoscope is in place.

How do I get ready for bronchoscopy?

A bronchoscopy may be done to diagnose and treat lung problems such as:

Tumors or bronchial cancer

Airway blockage (obstruction)

Narrowed areas in airways (strictures)

Inflammation and infections, such as tuberculosis (TB), pneumonia, and fungal or parasitic lung infections

Interstitial pulmonary disease

Causes of persistent cough

Causes of coughing up blood

Spots seen on chest X-rays

Vocal cord paralysis

Diagnostic procedures or treatments that are done with bronchoscopy include:

Biopsy of tissue

Collection of sputum

Fluid put into the lungs and then removed (bronchoalveolar lavage or BAL) to diagnose lung disorders

Your healthcare provider may also have other reasons to advise a bronchoscopy.

What happens during bronchoscopy?

You may have your procedure as an outpatient. This means you go home the same day. Or it may be done as part of a longer stay in the hospital. The way the procedure is done may vary. It depends on your condition and your healthcare provider's methods. In most cases, a bronchoscopy will follow this process:

You may be asked to remove your clothes. If so, you will be given a hospital gown to wear. You may be asked to remove jewelry or other objects.

You will sit on a procedure table with the head raised like a chair.

An intravenous (IV) line may be put into your arm or hand.

You may be given antibiotics before and after the procedure.

You will be awake during the procedure. You will be given medicine to help you relax (sedative). For a rigid bronchoscopy, you will be given general anesthesia. This is medicine that prevents pain and lets you sleep through the procedure

You may be given oxygen through a nasal tube or face mask. Your heart rate, blood pressure, and breathing will be watched during the procedure.

Numbing medicine will be sprayed into the back of your throat. This is to prevent gagging as the bronchoscope is passed down your throat. The spray may have a bitter taste to it. Once the tube passes down your throat the gagging feeling will go away.

You won’t be able to talk or swallow saliva during the procedure. Saliva will be suctioned from your mouth as needed.

The healthcare provider will move the bronchoscope down your throat and into the airways. You may have some discomfort. Your airway will not be blocked. You can breathe around the bronchoscope. You will be given extra oxygen if needed.

As the bronchoscope is moved down, the lungs will be examined. Tissue samples or mucus may be taken for testing. Other procedures may be done as needed. This may include giving medicine or stopping bleeding.

When the exam and other procedures are done, the bronchoscope will be taken out.

What happens after bronchoscopy?

After the procedure, you will spend some time in a recovery room. You may be sleepy and confused when you wake up from general anesthesia or sedation. Your healthcare team will watch your vital signs, such as your heart rate and breathing.

A chest X-ray may be done right after the procedure. This is to make sure your lungs are okay. You may be told to gently cough up and spit your saliva into a basin. This is so a nurse can check your secretions for blood.

You may have some throat discomfort. You will not be allowed to eat or drink until your gag reflex has returned. You may notice some throat soreness and pain with swallowing for a few days. This is normal. Using throat lozenges or gargle may help.

If you had an outpatient procedure, you will go home when your healthcare provider says it’s OK. Someone will need to drive you home.

At home, you can go back to your normal diet and activities if instructed by your healthcare provider. You may need to not do strenuous physical activity for a few days.

Call your healthcare provider if you have any of the below:

Fever of 100.4°F (38°C) or higher, or as advised by your healthcare provider

Redness or swelling of the IV site

Blood or other fluid leaking from the IV site

Coughing up significant amounts of blood

Chest pain

Severe hoarseness

Trouble breathing

Your healthcare provider may give you other instructions after the procedure.

Next steps

Before you agree to the test or the procedure make sure you know:

The name of the test or procedure

The reason you are having the test or procedure

What results to expect and what they mean

The risks and benefits of the test or procedure

What the possible side effects or complications are

When and where you are to have the test or procedure

Who will do the test or procedure and what that person’s qualifications are

What would happen if you did not have the test or procedure

Any alternative tests or procedures to think about

When and how will you get the results

Who to call after the test or procedure if you have questions or problems